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NPI Code Detail

MEDICARE: JORDAN BLAKE SCHWARTZBERG MD

MEDICARE:   JORDAN BLAKE SCHWARTZBERG  MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207ND0101XMOHS-Micrographic Surgery PhysicianME83158FL
2207N00000XDermatology PhysicianME83158FL

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
143286YOTHERFLMEDICARE ID

General Provider Information

NPI Number : 1265437891
Entity Type Code : Individual
Provider Name (Legal Business Name) : JORDAN BLAKE SCHWARTZBERG MD
Provider Business Mailing Address
First Line : 7740 BOYNTON BEACH BLVD
Second Line :
City : BOYNTON BEACH
State : FL
Zip : 33437-3804
Country : US
Telephone Number : 561-752-8000
Fax Number : 561-752-8001
Provider Business Practice Location Address
First Line : 9325 GLADES RD
Second Line : SUITE 207
City : BOCA RATON
State : FL
Zip : 33434-3988
Country : US
Telephone Number : 561-487-7575
Fax Number : 561-487-7576
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/20/2005
Last Update Date : 10/05/2015

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